Insurance Uncovered

You had suggested buying Apollo Munich’s Optima Restore. But I subscribed to the insurer’s Health Wallet Plan and paid premium. Is this a good policy?

G Surendra

We had suggested Optima Restore as it comes with restoration benefits and has no sub-limits. It is also competitive on premium.

Health Wallet from Apollo Munich is also a good one. This policy too is renewable life-long and has no sub-limits. It also comes with restore benefit — if the basic sum insured (SI) together with the sum from ‘multiplier’ benefit is exhausted due to claims made and paid during the policy year and accepted as payable, a restore SI equal to 100 per cent of the basic SI will be automatically available to the insured.

The ‘multiplier’ benefit is nothing but no-claim bonus. If the policyholder doesn’t make any claim for benefits under the policy, and the policy is renewed with Apollo Munich, the company will apply a bonus and enhance the renewed policy’s SI by 50 per cent of the basic SI of the previous year’s policy. In Optima Restore too, the no-claim bonus given is 50 per cent of the SI. So, you will see SI double after two no-claim years.

Health Wallet plan is different as it has a feature called ‘reserve benefit’. The SI available under the ‘reserve benefit’ can be used for OPD (out patient department) expenses or to pay for any of those expenses or items not covered under the policy. If unused, the SI available can also be used to pay up to 50 per cent of the renewal premium. Under OPD, expenses on diagnostic tests, vaccinations, pharmacy, consultations with a medical practitioner/therapist/psychologist and dental procedures are covered.

Every year, the reserve benefit increases by 6 per cent. This 6 per cent is applied on the original SI for the reserve benefit plus the bonuses added in the previous year less any amount utilised. The reserve benefit offers SI of ₹5,000 for ₹3 lakh cover and ₹5,000 for ₹5 lakh cover. For the maximum SI of ₹50 lakh under the policy, the reserve benefit offered is ₹25,000.

However, what you need to need to note is that OPD covers are always expensive. Insurers know well that only patients certain about claiming for OPD consultations or medicines, opt for this feature and, hence, increase the premium proportionately. In Health Wallet, as the OPD benefit increasesevery year, and you can also carry forward the unused SI, the asking premium is very expensive.

Sample this: For a ₹5 lakh cover, the premium in case of Optima Restore for a floater plan covering two adults — 49 years and 42 years and two children — 19 years and 13 years — will be ₹25,632. But for the same family, the Health Wallet plan will be ₹31,052.

We prefer Optima Restore to Health Wallet, as cost for the OPD cover is very expensive in the latter.

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